One in Four Support Doctors Who Lie to Insurers
3/21/2003
(Reuters) -- Recent survey results show that a quarter of the U.S. public has no qualms about doctors deceiving insurance companies in order to obtain services for their patients.
The study, published in the March 28th issue of the Annals of Internal Medicine, is believed to be the first to assess public attitudes regarding physicians' willingness to bend the rules. 700 people were surveyed as they waited to serve jury duty at the Philadelphia County courthouse in 1999.
The questionnaire presented two hypothetical situations in which a doctor might lie to obtain the desired test or service, and each participant was asked to consider one of the two scenarios. They could decide whether the doctor should accept the insurer's decision, appeal or misrepresent the facts.
In the first scenario, a 55-year-old with stable angina (recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood) was to undergo bypass surgery per her doctor's request. The insurer would only pay if symptoms of her heart disease worsened.
The second case involved a 55-year-old man with persistent back pain whose condition had not improved after conservative therapy. The doctor believed an MRI scan was needed, but the man's insurance company would not pay for the procedure unless his symptoms worsened or additional conservative therapy failed.
26% said it is O.K. to mislead an insurer to persuade it to pay for medical care
27% felt doctors lacked sufficient time to appeal insurance coverage restrictions
Among the 27%, half supported the use of deception by the doctors
Doctors who completed the survey felt differently. When confronted with the same survey vignettes, only 11% of doctors said they would tell a white lie to get coverage.
The researchers say the findings suggest that doctors seem to have to walk a tightrope in balancing their obligations to patients with their obligations to the larger society. They say that physicians and insurance companies need to work together to ensure that the appeals process is as streamlined as possible.
Susan Pisano, a spokeswoman for the American Association of Health Plans, cites problems with this study. First, "The two clinical vignettes bias the study because they do not represent the standard of care that you would expect to see." For instance, Pisano believes that the 55-year-old angina patient would be evaluated to see whether she was a good candidate for surgery.
Second, allegedly the study falsely assumes that the only reason for denying a service is financial. Pisano says that health plans in recent years have focused pre-authorization requirements on areas where there are questions about whether what's being proposed matches up with the science.